Restaurant Insurance Quote

Quote Request

Complete the following information if you would like to obtain a quote. Please understand this is not an application. An application will be sent to you if coverage is desired.

All information provided on this information sheet is confidential and will be used solely for the purpose of developing a quote for you.

    Personal Information

    *First Name

    *Last Name

    Business Name

    Street Address


    *Phone Number

    Alternate Number

    *Email Address

    Underwriting Information

    What is the nature of your business?

    Number of Owners

    Number of Employees

    Payroll of Owners

    Payroll of Employees

    Total annual gross receipts

    Total annual hard liquor receipts

    Total annual beer and wine receipts

    Total annual food gross receipts

    Business License Number

    License Type

    Years of experience

    Years operated under current name

    Is this business open 24 hours a day?


    Is there filling of propane tanks?


    Please describe ANY unusual exposures:

    Building and Property Information

    Property Street Address

    Total square footage of the building your business is in

    Total square footage of your business only

    Total square footage of the customer area only

    How many stories is it?


    If two stories, what is the ground floor square footage?

    What is the construction type?

    What type of roof covering?

    Was the roof updated?



    If yes, what year?

    What is the distance to fire protection?

    Is the business in a brush area?


    Do you have a storage area more than 1500 sq. ft?


    Are there smoke detectors at this location?


    Are there fire extinguishers?


    Are there deadbolts on all doors?


    Are there circuit breakers?


    Is the electrical updated?


    Is the heating / air conditioning thermostatically controlled?


    Is the heating / air conditioning central?


    Has the plumbing been updated?



    If yes, what year was the plumbing updated?

    Does the building have interior automatic fire sprinklers?


    Is there a theft alarm?


    Is there a fire alarm?


    Is the parking lot under your protection?


    Miscellaneous and Claims Information

    Were there any losses or claims in the last 5 years?



    If yes, what is the date, amount paid and description of each loss or claim?

    Current Insurance Company

    How much are you paying now?

    What is the renewal date?

    Has insurance ever been cancelled?



    If yes, describe

    Have you ever had regulatory violations or citations?



    If yes, describe

    Are employees trained on how to handle minors or intoxicated customers?



    If yes, describe

    Coverage Information

    What building coverage is requested?

    What other structures is requested?

    What business contents is requested?

    What is the loss of use coverage requested?

    What is the liability limit requested?

    What is the policy deductible requested?

    What is the business personal property (contents) limit requested?

    What is the contents deductible requested?

    Questions or Comments

    Best Time To Contact You

    Please let us know the best time to call and discuss your quote


    Or Specify Other:

    *Please prove you're human by entering the Captcha characters